Texicare

Customer Support

• Respond to inquiries from members, providers, and brokers, delivering timely, accurate, and high-quality service.
• Phone will be the primary channel of communication, with some use of email and chat as well.
• Manage the end-to-end lifecycle of inquiries, ensuring clear communication, thorough follow-up, and complete resolution.
• Research and resolve issues related to benefits, eligibility, claims status, billing discrepancies, and cost-sharing.
• Interpret plan documents, policies, and internal guidelines to provide clear and accurate guidance.
• Initiate and track claims adjustments, reprocessing, or escalations in accordance with established procedures.
• Identify root causes of issues, address underlying needs, and recommend process improvements.
• Document all interactions in the CRM system (Salesforce) in compliance with HIPAA, privacy, and audit requirements.
• Collaborate with cross-functional teams to validate data, resolve issues, and address systemic challenges.
• Regularly work a schedule of 8:00 a.m. to 5:00 p.m. Central time, Mondays through Fridays.
• Serve as an escalation point for complex or sensitive inquiries, ensuring effective and timely resolution.
• Act as a subject matter expert, providing guidance on complex benefits, claims, and policy scenarios.
• Lead cross-functional coordination to resolve high-impact issues and drive sustainable solutions.
• Mentor and support team members through coaching, training, and knowledge sharing.
• Contribute to quality assurance and continuous improvement efforts, modeling best-in-class service delivery.

Intermediate/Senior Customer Experience Advocate